Evaluating existing recommendations for hepatitis A and B vaccination

Hepatitis A and hepatitis B vaccines are now widely available throughout the United States, Europe, and most of the rest of the world. A recombinant hepatitis B vaccine was licensed in the United States in 1986, followed by hepatitis A vaccine in 1995. Official recommendations from the Advisory Committee on Immunization Practices were published for hepatitis B vaccine in 1990, with revisions in 1991, and for hepatitis A vaccine in 1999. Unfortunately, the recommendations are not closely followed, and an insufficient number of persons who are at risk receive these vaccines. In addition, the available recommendations may not cover all who are at risk for infection. This article reviews existing recommendations for the use of hepatitis A and hepatitis B vaccines and offers suggestions for situations in which additional recommendations may be useful. The rationale for revising and expanding the existing recommendations is based on questions raised about the value of risk-based recommendations, data demonstrating increasing rates of hepatitis A and B infections in specific age groups, and the failure to protect ⩽50% of individuals who become infected with vaccine-preventable hepatitis.